Incidence of dysphagia comparing cervical arthroplasty and ACDF.

STUDY DESIGN: Retrospective cohort from randomized prospective clinical trial. OBJECTIVE: Evaluate incidence of dysphagia between instrumented ACDF and a no-profile cervical disc arthroplasty. SUMMARY OF BACKGROUND DATA: Dysphagia is a well-known complication following anterior cervical discectomy and fusion (ACDF) and the etiology is multifactorial. One potential source for postoperative dysphagia involves the anterior profile of the implant used. Hence, a no-profile cervical disc arthroplasty could theoretically have fewer soft tissue adhesions and a lower incidence of dysphagia. The purpose of this study is to compare the incidence of dysphagia at least 1 year postoperatively following ACDF with anterior plating and a no-profile cervical disc arthroplasty. METHODS: A cohort of 87 patients meeting the inclusion criteria for the prospective, randomized, multicenter IDE trial of ProDisc-C versus ACDF were evaluated for dysphagia. Forty-five patients were randomized to receive cervical arthroplasty and 42 patients were randomized to the ACDF and plate group. The Bazaz-Yoo dysphagia questionnaire was administered in a blinded fashion after completion of at least 12 months follow-up. RESULTS: Follow-up averaged 18.2 months and included 76 (87%) of the 87 enrolled, with 38 of the original 45 in the arthroplasty group and 38 of the original 42 in the ACDF group. Six of 38 (15.8%) in the arthroplasty group versus 16 of 38 (42.1%) in the ACDF group reported ongoing dysphagia complaints. This was found to be statistically significant (P = .03). CONCLUSION: This study suggests a significantly lower rate of dysphagia with a no-profile cervical disc arthroplasty compared to instrumented ACDF for single level disc disease between C3-7. Though there are many potential etiologies, we hypothesize this is related to the lack of anterior hardware in the retropharyngeal space. Operative technique, operating time, and significant midline retraction did not seem to result in more dysphagia complaints. Future studies comparing cervical disc arthroplasty and no-profile fusion devices may help delineate the effect that anterior instrumentation profile has on postoperative dysphagia.

Sagittal split fractures in multilevel cervical arthroplasty using a keeled prosthesis.

This is a case report of intraoperative sagittal split fractures in multilevel cervical disc replacement using a keeled prosthesis. The patient's clinical course is discussed and outcomes measured with the SF-36 questionnaire, oswestry disability index, and visual analog scale neck pain are compared with the other patients at our institution that have undergone multilevel disc replacement. The patient did well and has not had any complications related to the device used or fractures. The risks and techniques to avoid this complication when using a keeled prosthesis are discussed in detail.

The use of computed tomography angiography to define the prevertebral vascular anatomy prior to anterior lumbar procedures.

STUDY DESIGN: Prospective cohort. OBJECTIVE: To determine the efficacy of a single-slice computed tomography (CT) angiogram to define the prevertebral anatomy in patients undergoing an anterior lumbar spine procedure. SUMMARY OF BACKGROUND DATA: Preoperative planning with precise prevertebral anatomic details can help in mini-open anterior lumbar approaches. METHODS: A total of 76 consecutive patients undergoing a minimal incision approach for anterior lumbar surgery were evaluated before surgery with CT angiography. The prevertebral anatomy was documented, and the patients were observed during treatment. RESULTS: There were no complications related to CT angiography. This study directly influenced surgical decision making and the treatment options in 21% of patients. The vena caval confluence limited access to the L5-S1 disc in 3% of patients and at the L4-L5 disc in 92% of the patients. Prevertebral anatomic anomalies were found in 11.8% of patients. Atherosclerotic disease was discovered in 17% of the patients. The major complication rate was 7.5%. CT angiography correlated with intraoperative vascular anatomy in all cases. CONCLUSION: Preoperative CT angiography before anterior approaches was determined to be effective in evaluating the prevertebral vascular anatomy.